Improving prevalence estimates of mental health and well-being indicators among Sexual Minority Men: A Propensity Weighting Approach.

The prevalence and relative disparities of mental health outcomes and well-being indicators are often inconsistent across studies of Sexual Minority Men (SMM) due to selection biases in community-based surveys (non-probability sample), as well as misclassification biases in population-based surveys where some SMM often conceal their sexual orientation identities. The current paper estimated the prevalence of mental health related outcomes (depressive symptoms, mental health service use [MHSU], anxiety) and well-being indicators (loneliness and self-rated mental health) among SMM, broken down by sexual orientation using the Adjusted Logistic Propensity score (ALP) weighting. We applied the ALP to correct for selection biases in the 2019 Sex Now data (a community-based survey of SMMs in Canada) by reweighting it to the 2015-2018 Canadian Community Health Survey (a population survey from Statistics Canada). For all SMMs, the ALP-weighted prevalence of depressive symptoms is 15.96% (95% CI: 11.36%, 23.83%), while for MHSU, it is 32.13% (95% CI: 26.09, 41.20). The ALP estimates lie in between the crude estimates from the two surveys. This method was successful in providing a more accurate estimate than relying on results from one survey alone. We recommend to the use of ALP on other minority populations under certain assumptions.

Standards for fecal microbiota transplant: Tools and therapeutic advances.

Fecal microbiota transplantation (FMT) has been demonstrated to be efficacious in preventing recurrent Clostridioides difficile (C. difficile) infections, and is being investigated for treatment of several other diseases including inflammatory bowel disease, cancer, obesity, liver disease, and diabetes. To speed up the translation of FMT into clinical practice as a safe and standardized therapeutic intervention, additional evidence-based technical and regulatory guidance is needed. To this end in May of 2022, the International Alliance for Biological Standardization (IABS) and the BIOASTER Microbiology Technology Institute hosted a second webinar to discuss key issues still impeding the advancement and standardization of FMT. The goal of this two-day webinar was to provide a forum for scientific experts to share and discuss data and key challenges with one another. Discussion included a focus on the evaluation of safety, efficacy, clinical trial design, reproducibility and accuracy in obtained microbiome measurements and data reporting, and the potential for standardization across these areas. It also focused on increasing the application potential and visibility of FMT beyond treating C. difficile infections.

Dialect and mathematics performance in African American children who use AAE: Insights from explanatory IRT and error analysis.

Little is known about mismatches between the language of mathematics testing instruments and the rich linguistic repertoires that African American children develop at home and in the community, in part because research paradigms with African American English (AAE) dialect speakers face complex challenges in measurement, historical exclusion, and other social, economic, cultural, and linguistic confounds. The current study aims to provide a proof of concept and novel explanatory item response design that uses error analysis to investigate the relationship between AAE child language and children's mathematics assessment outcomes. Here, we illustrate 2nd and 3rd grade children's qualitative patterns of performance on arithmetic tasks in relation to their AAE dialect use and elaborate a unified framework for examining child and item level linguistic characteristics. Results suggest that children draw upon their emerging (bi)dialectal repertoire with arithmetic problems when selecting appropriate problem-solving strategies on language-formatted problems. The mismatch of assessment language formatting with children's repertoires may disadvantage AAE speakers' strategy selections and result in a language-based performance disadvantage unrelated to mathematical ability. Research designs that look beyond correct/incorrect scoring to examine qualitative patterns of performance in AAE speaking children can provide valuable and oft-overlooked evidence when considering equity in mathematics assessment formats.

Different Responses to Social Capital Among Black People and White People: What Racial Differential Item Functioning Reveals for Racial Health Equity.

Social capital has been conceptualized as features of social organization, such as networks, and norms that facilitate coordination and cooperation for mutual benefit. Because of long-standing anti-Black structural oppression in the United States, social capital may be associated with health differently for Black people than for other racial/ethnic groups. Our aim was to examine the psychometric properties of social capital indicators, comparing responses from Black and White people to identify whether there is differential item functioning (DIF) in social capital according to race. DIF examines how items are related to a latent construct and whether this relationship differs across groups such as different racial groups. We used data from respondents to the Southeastern Pennsylvania Household Health Survey in 2004, who lived in Philadelphia (n = 2,048), a city with a large Black population. We used item response theory analysis to test for racial DIF. We found DIF across the items, indicating measurement error, which could be related to the way these items were developed (i.e., based on cultural assumptions tested in mainstream White America). Hence, our findings underscore the need to interrogate the assumptions that underly existing social capital items through an equity-based lens, and to take corrective action when developing new items to ensure that they are racially and culturally congruent.

The accuracy of pulse oximetry in measuring oxygen saturation by levels of skin pigmentation: a systematic review and meta-analysis.

BACKGROUND: During the COVID-19 pandemic, there have been concerns regarding potential bias in pulse oximetry measurements for people with high levels of skin pigmentation. We systematically reviewed the effects of skin pigmentation on the accuracy of oxygen saturation measurement by pulse oximetry (SpO2) compared with the gold standard SaO2 measured by CO-oximetry. METHODS: We searched Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform (up to December 2021) for studies with SpO2-SaO2 comparisons and measuring the impact of skin pigmentation or ethnicity on pulse oximetry accuracy. We performed meta-analyses for mean bias (the primary outcome in this review) and its standard deviations (SDs) across studies included for each subgroup of skin pigmentation and ethnicity and used these pooled mean biases and SDs to calculate accuracy root-mean-square (Arms) and 95% limits of agreement. The review was registered with the Open Science Framework ( https://osf.io/gm7ty ). RESULTS: We included 32 studies (6505 participants): 15 measured skin pigmentation and 22 referred to ethnicity. Compared with standard SaO2 measurement, pulse oximetry probably overestimates oxygen saturation in people with the high level of skin pigmentation (pooled mean bias 1.11%; 95% confidence interval 0.29 to 1.93%) and people described as Black/African American (1.52%; 0.95 to 2.09%) (moderate- and low-certainty evidence). The bias of pulse oximetry measurements for people with other levels of skin pigmentation or those from other ethnic groups is either more uncertain or suggests no overestimation. Whilst the extent of mean bias is small or negligible for all subgroups evaluated, the associated imprecision is unacceptably large (pooled SDs > 1%). When the extent of measurement bias and precision is considered jointly, pulse oximetry measurements for all the subgroups appear acceptably accurate (with Arms < 4%). CONCLUSIONS: Pulse oximetry may overestimate oxygen saturation in people with high levels of skin pigmentation and people whose ethnicity is reported as Black/African American, compared with SaO2. The extent of overestimation may be small in hospital settings but unknown in community settings. REVIEW PROTOCOL REGISTRATION: https://osf.io/gm7ty.

Differential frequency in imaging-based outcome measurement: Bias in real-world oncology comparative-effectiveness studies.

BACKGROUND: Comparative-effectiveness studies using real-world data (RWD) can be susceptible to surveillance bias. In solid tumor oncology studies, analyses of endpoints such as progression-free survival (PFS) are based on progression events detected by imaging assessments. This study aimed to evaluate the potential bias introduced by differential imaging assessment frequency when using electronic health record (EHR)-derived data to investigate the comparative effectiveness of cancer therapies. METHODS: Using a nationwide de-identified EHR-derived database, we first analyzed imaging assessment frequency patterns in patients diagnosed with advanced non-small cell lung cancer (aNSCLC). We used those RWD inputs to develop a discrete event simulation model of two treatments where disease progression was the outcome and PFS was the endpoint. Using this model, we induced bias with differential imaging assessment timing and quantified its effect on observed versus true treatment effectiveness. We assessed percent bias in the estimated hazard ratio (HR). RESULTS: The frequency of assessments differed by cancer treatment types. In simulated comparative-effectiveness studies, PFS HRs estimated using real-world imaging assessment frequencies differed from the true HR by less than 10% in all scenarios (range: 0.4% to -9.6%). The greatest risk of biased effect estimates was found comparing treatments with widely different imaging frequencies, most exaggerated in disease settings where time to progression is very short. CONCLUSIONS: This study provided evidence that the frequency of imaging assessments to detect disease progression can differ by treatment type in real-world patients with cancer and may induce some bias in comparative-effectiveness studies in some situations.

Temporal Alignment of Dual Monitor Accelerometry Recordings.

Combining accelerometry from multiple independent activity monitors worn by the same subject have gained widespread interest with the assessment of physical activity behavior. However, a difference in the real time clock accuracy of the activity monitor introduces a substantial temporal misalignment with long duration recordings which is commonly not considered. In this study, a novel method not requiring human interaction is described for the temporal alignment of triaxial acceleration measured with two independent activity monitors and evaluating the performance with the misalignment manually identified. The method was evaluated with free-living recordings using both combined wrist/hip (n = 9) and thigh/hip device (n = 30) wear locations, and descriptive data on initial offset and accumulated day 7 drift in a large-scale population-based study (n = 2513) were calculated. The results from the Bland-Altman analysis show good agreement between the proposed algorithm and the reference suggesting that the described method is valid for reducing the temporal misalignment and thus reduce the measurement error with aggregated data. Applying the algorithm to the n = 2513 samples worn for 7-days suggest a wide and substantial issue with drift over time when each subject wears two independent activity monitors.

A Thermal Skin Model for Comparing Contact Skin Temperature Sensors and Assessing Measurement Errors.

To improve the measurement and subsequent use of human skin temperature (Tsk) data, there is a need for practical methods to compare Tsk sensors and to quantify and better understand measurement error. We sought to develop, evaluate, and utilize a skin model with skin-like thermal properties as a tool for benchtop Tsk sensor comparisons and assessments of local temperature disturbance and sensor bias over a range of surface temperatures. Inter-sensor comparisons performed on the model were compared to measurements performed in vivo, where 14 adult males completed an experimental session involving rest and cycling exercise. Three types of Tsk sensors (two of them commercially available and one custom made) were investigated. Skin-model-derived inter-sensor differences were similar (within ±0.4 °C) to the human trial when comparing the two commercial Tsk sensors, but not for the custom Tsk sensor. Using the skin model, all surface Tsk sensors caused a local temperature disturbance with the magnitude and direction dependent upon the sensor and attachment and linearly related to the surface-to-environment temperature gradient. Likewise, surface Tsk sensors also showed bias from both the underlying disturbed surface temperature and that same surface in its otherwise undisturbed state. This work supports the development and use of increasingly realistic benchtop skin models for practical Tsk sensor comparisons and for identifying potential measurement errors, both of which are important for future Tsk sensor design, characterization, correction, and end use.

No Evidence of Bias in Sexual Partnership Corroboration by Race and Ethnicity Among a Diverse Cohort of Young Men Who Have Sex with Men and Transgender Women.

Black men who have sex with men (MSM) continue to experience disproportionately high HIV incidence rates relative to their white peers. Yet, Black MSM do not report higher levels of sexual risk behavior, and contextual factors such as access to care and sexual networks only partially explain these disparities. However, risk misclassification could help explain this paradox, if measurement biases systematically underestimate sexual risk behavior among Black MSM relative to their peers. The current study examined variation in sexual partnership corroboration in the RADAR study, a large and diverse cohort of young MSM and transgender women. Network data were elicited regarding all sexual partners in the prior 6 months, including instances where participants reported other participants as sexual partners. Using these data, anal and condomless anal sex partners were separately examined using a series of exponential random graph models to estimate the rate of corroboration of sexual connections between participants and examine whether this parameter varied by race/ethnicity. For both types of behavior, providing separate estimates for corroboration across race/ethnicity groups reduced model fit and did not significantly vary across groups. Accordingly, we found no evidence of measurement bias by race/ethnicity in the current data. However, overall rates of corroboration (41.2-50.3%) were low, suggesting substantial levels of measurement error. Accordingly, it is vital that researchers continue to improve upon methods to measure risk behavior in order to maximize their validity. We discuss the implications of these findings, including potential alternative causes of risk misclassification (e.g., sampling bias) and future directions to reduce measurement error.

Comparing South Korean and US self-rated health using anchoring vignettes.

PURPOSE: This study compares the self-rated health (SRH) of South Korean and US respondents, using anchoring vignettes to adjust for reporting heterogeneity, i.e., cross-national differences in use of response categories. METHODS: Study participants, ages 20 to 59, were recruited from online survey panels retained by Embrain in Korea (N = 1170) and the US (N = 1033). In the analyses, we first examined the two key measurement assumptions of the anchoring vignette method. Response consistency was examined by regressing SRH on vignette ratings and EQ-5D, and was satisfied when the relationship between SRH and vignette ratings was significant and positive. Vignette equivalence was assessed by examining whether respondents correctly rank-ordered vignettes by health status severity. We then compared estimates of the between-country difference in SRH from two models: a standard ordered probit regression, and a hierarchical ordered probit (Hopit) regression, which adjusted for cross-country differences in use of response categories. RESULTS: The anchoring vignettes satisfied both measurement assumptions. Results from the ordered probit regression indicated that Korean SRH was worse than that in the US. However, results from the Hopit regression revealed that Korean SRH was actually better than that in the US, after adjusting for Korean respondents' significantly higher intercategory thresholds (demarcating between "very bad" and "bad," "bad" and "fair," etc.). CONCLUSION: The apparently lower SRH of Korean vis-à-vis US respondents is an artifact of Koreans' higher standards for health-related response categories. After adjusting for these different standards, Korean SRH is revealed to be higher than US SRH.

Income Segregation: Up or Down, and for Whom?

Reports of rising income segregation in the United States have been brought into question by the observation that post-2000 estimates are upwardly biased because of a reduction in the sample sizes on which they are based. Recent studies have offered estimates of this sample-count bias using public data. We show here that there are two substantial sources of systematic bias in estimating segregation levels: bias associated with sample size and bias associated with using weighted sample data. We rely on new correction methods using the original census sample data for individual households to provide more accurate estimates. Family income segregation rose markedly in the 1980s but only selectively after 1990. For some categories of families, segregation declined after 1990. There has been an upward trend for families with children but not specifically for families with children in the upper or lower 10% of the income distribution. Separate analyses by race/ethnicity show that income segregation was not generally higher among Blacks and Hispanics than among White families, and evidence of income segregation trends for these separate groups is mixed. Income segregation increased for all three racial groups for families with children, particularly for Hispanics (but not Whites or Blacks) in the upper 10% of the income distribution. Trends vary for specific combinations of race/ethnicity, presence of children, and location in the income distribution, offering new challenges for understanding the underlying processes of change.

Using fathers as a negative control exposure: Implications of measurement bias.

Negative control exposure analysis is a very effective tool in evaluating the effect of unmeasured confounding in observational epidemiological studies. Several biases, including recall bias, time-varying confounding factors, measurement bias and so on, can affect the credibility of negative control exposure analysis for causal interpretations. The article focuses on the implications of differential measurement error across exposed group and negative controls to causal interpretations on negative control exposure analysis.

Differential item functioning of the SF-12 in a population-based regional joint replacement registry.

BACKGROUND: Joint replacement, an increasingly common procedure amongst older adults, can substantially improve health-related quality of life (HRQoL). However, differential item functioning (DIF) may affect the accurate interpretation of differences in HRQoL amongst patients with different demographic and health status characteristics but the same underlying (i.e., latent) level of the investigated construct. This study tested for DIF in pre-operative SF-12 physical health (PH) and mental health (MH) sub-scale items amongst patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Data were from a population-based joint replacement registry from the Canadian province of Manitoba. TKA and THA patients who had surgery between 2009 and 2015 and completed a pre-operative assessment were included. DIF was tested using the multiple indicators multiple causes (MIMIC) method with sex, age group, body weight status, and presence of multiple comorbid conditions (i.e., multimorbidity) as covariates. Analyses were stratified by joint type. RESULTS: The study cohort included 8820 patients; 42.1% underwent THA, 57.3% were female, 32.7% were 70+ years, and 52.8% were obese. For each sub-scale, four of the six items exhibited DIF in both THA and TKA groups. Differences in the covariate effect estimates for DIF and No-DIF models on the MH latent variable were largest for age and body weight status for the THA group, and for sex and multimorbidity for the TKA group. All of the differences were small for PH. Multimorbidity had the strongest association with PH and age and sex had the strongest association with MH in the DIF models. CONCLUSIONS: Demographic and health status characteristics influenced SF-12 PH and MH item responses in joint replacement populations, although the size of the effects were not large for PH. We recommend testing and adjusting for DIF effects to ensure comparability of HRQoL measures in joint replacement populations.

Effects of freezing on length and mass measurements of Atlantic cod Gadus morhua in the Baltic Sea.

An aggregated sample of 925 Atlantic cod Gadus morhua collected by four countries in different regions of the Baltic Sea during different seasons were measured (total length, LT = 161-890 mm and weighed (mass, M = 45-6900 g) both before freezing and after defrosting. The cod were found to decrease significantly in both LT and M following death and frozen storage. There was an average (±SD) change in LT of -2.91% (±0.05%) following freezing, independent of starting LT . Total M changed by -2.65% (±0.14%), independent of starting mass. Shrinkage of LT and M did not differ significantly between 1 and 4 months frozen storage, though LT shrinkage was significantly greater after 1 or 4 months in the freezer compared with after 5 days. There was significant variation in LT and M shrinkage between regions of capture. A significant negative relationship between condition of cod and LT or M change was also observed. Equations to back-calculate fresh LT and M from thawed LT , M and standard length (LS ), gutted LT , gutted LS and gutted M are provided.

Finding Spirits in Spirituality: What are We Measuring in Spirituality and Health Research?

What are we asking when we ask about spirituality? When research subjects check survey boxes for "religiosity" and "spirituality" measures on health surveys, those of us who use them often assume that these responses indicate a relationship with-or reaction against-normative, conventional, Protestant-shaped religious practice and experience. We present a qualitative interview study of 13 low-income mothers with a history of depression, analyzing their descriptions of spiritual and religious coping practices. On the basis of a focused analysis of four mother's narratives, we argue that conventional survey answers may frequently hide more than they reveal about people's cultural, religious, and idiosyncratic experiences with ghosts, spirits, magic, and haunting presences that are relevant, sometimes integral, to illness and healing. We demonstrate that listening to participants' narratives challenges researchers' unconsciously normative assumptions and ought to help us reshape our understanding of the ways spirituality and religion influence health in a hyperdiverse society.

Self-Other Differences in Student Drinking Norms Research: The Role of Impression Management, Self-Deception, and Measurement Methodology.

BACKGROUND: Data-driven student drinking norms interventions are based on reported normative overestimation of the extent and approval of an average student's drinking. Self-reported differences between personal and perceived normative drinking behaviors and attitudes are taken at face value as evidence of actual levels of overestimation. This study investigates whether commonly used data collection methods and socially desirable responding (SDR) may inadvertently impede establishing "objective" drinking norms. METHODS: U.K. students (N = 421; 69% female; mean age 20.22 years [SD = 2.5]) were randomly assigned to 1 of 3 versions of a drinking norms questionnaire: The standard multi-target questionnaire assessed respondents' drinking attitudes and behaviors (frequency of consumption, heavy drinking, units on a typical occasion) as well as drinking attitudes and behaviors for an "average student." Two deconstructed versions of this questionnaire assessed identical behaviors and attitudes for participants themselves or an "average student." The Balanced Inventory of Desirable Responding was also administered. RESULTS: Students who answered questions about themselves and peers reported more extreme perceived drinking attitudes for the average student compared with those reporting solely on the "average student." Personal and perceived reports of drinking behaviors did not differ between multitarget and single-target versions of the questionnaire. Among those who completed the multitarget questionnaire, after controlling for demographics and weekly drinking, SDR was related positively with the magnitude of difference between students' own reported behaviors/attitudes and those perceived for the average student. CONCLUSIONS: Standard methodological practices and socially desirable responding may be sources of bias in peer norm overestimation research.

Constructing a Time-Invariant Measure of the Socio-economic Status of U.S. Census Tracts.

Contextual research on time and place requires a consistent measurement instrument for neighborhood conditions in order to make unbiased inferences about neighborhood change. We develop such a time-invariant measure of neighborhood socio-economic status (NSES) using exploratory and confirmatory factor analyses fit to census data at the tract level from the 1990 and 2000 U.S. Censuses and the 2008-2012 American Community Survey. A single factor model fit the data well at all three time periods, and factor loadings--but not indicator intercepts--could be constrained to equality over time without decrement to fit. After addressing remaining longitudinal measurement bias, we found that NSES increased from 1990 to 2000, and then--consistent with the timing of the "Great Recession"--declined in 2008-2012 to a level approaching that of 1990. Our approach for evaluating and adjusting for time-invariance is not only instructive for studies of NSES but also more generally for longitudinal studies in which the variable of interest is a latent construct.

An item-level response shift study on the change of health state with the rating of asthma-specific quality of life: a report from the PROMIS(®) Pediatric Asthma Study.

PURPOSE: To examine item-level response shift associated with the change in asthma-related health state (i.e., change in asthma control status and global rating of change (GRC) in breathing problems). METHODS: Study sample comprised 238 asthmatic children who were between 8 and 17.9 years and completed the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) symptoms, emotion function, and activity limitation domains at baseline and a follow-up assessment. Structural equation modeling was implemented to assess item-level response shift associated with the change in asthma-related health state with the adjustment for the influence of confounding variables. The magnitude of item-level response shift and its influence on the change of domain scores was estimated using Cohen's effect sizes. RESULTS: We found no instances of item-level response shift. However, two items were identified with measurement bias related to GRC due to breathing problems. Specifically, asthmatic children with better/about the same GRC due to breathing problems reported lower scores for one item in the emotional domain at follow-up compared to those with deteriorated GRC due to breathing problems. In addition, asthmatic children with better/about the same GRC due to breathing problems reported better scores for another item in the symptom domain at baseline compared to those with deteriorated GRC due to breathing problems. The impact of measurement bias was small and did not bias the change of domain scores over time. CONCLUSIONS: No item-level response shift, but two instances of measurement bias, appears in asthmatic children. However, the impact of these measurement issues is negligible.

On the validity of measuring change over time in routine clinical assessment: a close examination of item-level response shifts in psychosomatic inpatients.

OBJECTIVE: Significant life events such as severe health status changes or intensive medical treatment often trigger response shifts in individuals that may hamper the comparison of measurements over time. Drawing from the Oort model, this study aims at detecting response shift at the item level in psychosomatic inpatients and evaluating its impact on the validity of comparing repeated measurements. STUDY DESIGN AND SETTING: Complete pretest and posttest data were available from 1188 patients who had filled out the ICD-10 Symptom Rating (ISR) scale at admission and discharge, on average 24 days after intake. Reconceptualization, reprioritization, and recalibration response shifts were explored applying tests of measurement invariance. In the item-level approach, all model parameters were constrained to be equal between pretest and posttest. If non-invariance was detected, these were linked to the different types of response shift. RESULTS: When constraining across-occasion model parameters, model fit worsened as indicated by a significant Satorra-Bentler Chi-square difference test suggesting potential presence of response shifts. A close examination revealed presence of two types of response shift, i.e., (non)uniform recalibration and both higher- and lower-level reconceptualization response shifts leading to four model adjustments. CONCLUSIONS: Our analyses suggest that psychosomatic inpatients experienced some response shifts during their hospital stay. According to the hierarchy of measurement invariance, however, only one of the detected non-invariances is critical for unbiased mean comparisons over time, which did not have a substantial impact on estimating change. Hence, the use of the ISR can be recommended for outcomes assessment in clinical routine, as change score estimates do not seem hampered by response shift effects.